Accessibility of Drug Information on Ocular Drug Product Websites in the United States

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Previous studies found pharmaceutical websites did not meet accessibility standards. This study builds on previous research by evaluating accessibility of prescription ocular drug product websites using two accessibility checkers. Methods Twenty ocular medications were initially selected and 11 medications were included in the final analysis because a product website was available. AChecker and WAVE tools were used to evaluate accessibility of each drug product homepage then a screen reader was used to verify accessibility of the websites. Descriptive statistics were used to represent the errors and problems identified by the accessibility checkers. Results All websites had varying number of errors and problems based on the WAVE and AChecker tool. Travatan Z® had the highest number of errors of 117 according to WAVE and Durysta™ had the highest of 42 problems based on the AChecker tool. Some of the common issues identified by the screen reader included lack of alternative text for images (e.g., graphs), no description for links, and drop-down menus do not expand using the keyboard functions. Conclusion This study highlights the need for manufacturers to improve accessibility of their product websites. Due to the lack of accessible content on these websites, it is prudent for pharmacists and other healthcare professionals to provide education through verbal counseling and providing auditory resources or recordings of drug information as an alternative format. disability screen reader drug resource web accessibility pharmaceutical industry Introduction The internet is a commonly used resource for consumers to find drug information because of ease of use and convenience; however, accessibility of websites for individuals with visual impairment or blindness may not be considered [ 1 , 2 ]. Accessibility includes a range of disabilities including physical, auditory, cognitive, language, learning, speech, and neurological disabilities [ 3 ]. Section 508 of the Rehabilitation Act Amendments and Section 225 of the Telecommunications Act of 1996 describe web accessibility standards for federal or government websites [ 4 ]. Web accessibility is defined as making websites usable for people with disabilities to navigate and interact with content while using assistive technology such as a screen reader [ 3 ]. In the literature, studies have shown public health websites including the U.S., Korea, Iberia, and Canada remains at a low conformance level to accessibility guidelines or standards which present significant issues for individuals with disabilities in obtaining important health information from government officials [ 5 , 6 , 7 , 8 , 9 ]. Other studies have also assessed the accessibility of COVID-19 vaccine registration websites and health information. A recent study evaluated the accessibility of 54 official COVID-19 vaccine registration websites using the POUR framework from the most recent Web Content Accessibility Guidelines (WCAG 2.0, 2.1) published by the World Wide Web Consortium (W3C). The study found up to five state registration websites “passed” by having zero errors identified by the WAVE, AChecker, and SortSite evaluation tools. This study highlighted the majority of the vaccine registration websites were not compliant with accessibility guidelines and state authorities should improve accessibility to ensure that individuals with disabilities can schedule vaccine appointments [ 10 ]. Two studies assessed the accessibility of health information found in popular websites. One study evaluated 108 consumer health information websites using the number of violations of Web Accessibility Barrier checkpoints. None of the Web sites evaluated were completely accessible to people with disabilities as every website consisted of at least one violation of Web accessibility rules. Government and educational health information Web sites had less violations compared to other websites [ 11 ]. Another study assessed accessibility of 138 websites featuring disease state information using a checklist of Checkpoints for Web Content Accessibility Guidelines 1.0. This study showed that not even one fifth of all web sites containing health information evaluated meets the minimal requirements of accessibility according to the WAI guidelines (priority 1/level A). For this reason, the information presented can be accessed only partially or not at all by users with visually impairment or blindness [ 12 ]. The objective of this study is to build on previous studies by evaluating the accessibility of manufacturers’ website featuring drug information on ocular products using two accessibility checkers. Methods The drugs included in the analysis for this study were obtained from drug class overviews found in tertiary databases (e.g., Clinical Pharmacology and Micromedex) and a published review on ocular products [ 13 ]. Patients with ophthalmic diseases are likely to have reduced visual acuity or another visual impairment. The list initially consisted of 20 drugs; however, there were only 11 drugs that had a drug product website. The drugs included in the final analysis are as follows: Alphagan P®, Travatan Z®, Lumigan®, Rhopressa®, Vyzulta®, Combigan®, Rocklatan®, Tepezza®, Luxturna™, Durysta™, Xalatan®. The accessibility of each drug product homepage was evaluated based on the World Wide Web Consortium's (W3C) Web Content Accessibility Guidelines (WCAG). The WCAG 2.0 was originally published in 2008 then was revised to version 2.1 in 2018. The WCAG 2.1 version has 12 guidelines, and 78 success criteria consisting of 61 success criteria from WCAG 2.0 and 17 new success criteria relevant to mobile devices and visual and cognitive impairment. The 12 guidelines are based on the POUR principles of 1) Perceivable-information and user interface components must be presentable to users in ways they can perceive; 2) Operable-user interface components and navigation must be operable; 3) Understandable-information and the operation of the user interface must be understandable; and 4) Robust-content must be robust enough that it can be interpreted reliably by a wide variety of user agents, including assistive technologies. Each of these guidelines have success criteria that determine conformance to WCAG and are based on a three-compliance levels: Level AAA (highest conformance), Level AA (intermediate conformance), level A (minimal conformance). Moreover, the conformance level determines the extent to which a website follows the accessibility guidelines. Content compliant with WCAG 2.1 would also comply with WCAG 2.0 standards. Two free tools, WAVE and AChecker, were used to evaluate website accessibility according to WCAG and have been used in previous studies that assessed health-related websites. WAVE was created by WebAIM in 2001 and provides color-coded icons to enable testers to check for possible accessibility problems on a web page using a color-coded system. The red icons designate accessibility and contrast errors; yellow is related to accessibility problems (alerts) where human judgment is needed; green define features that improve accessibility when implemented properly; blue icons speak to structural, navigational, or semantic elements; purple showcases the use of ARIA within a webpage which provides enhanced semantics and accessibility for web content but older browsers and assistive technologies may not support this feature. WAVE was used to assess the web accessibility of the selected drug websites against the WCAG 2.1 standard [ 14 ]. AChecker is the most commonly used tool for WCAG 2.0 verification and provides three categories of problems: “known” refers to certain accessibility barriers that should be resolved, “likely” designates probable barriers that require human decision, and “potential” designates AChecker is unable to identify problems, requiring a human check [ 15 ]. Testing of each product website using these two tools were conducted in October 2021 and all webpages were analyzed using the website (URL) links. Job Access with Speech (JAWS®) screen reader was then utilized to read through the content presented on the homepage of each product website. This software was chosen as it is among one of the most commonly used screen readers for Windows devices and allows for users that are blind or visually impaired to read the text displayed on the computer screen with a speech synthesizer [ 16 ]. JAWS was then used to confirm any errors or alerts found by two accessibility checkers. Descriptive statistics (percentages) were used to present the errors and problems identified by both tools. IRB oversight was provided by the University of Kansas Human Research Protection Program for this study. Results All websites had varying number of errors and problems based on the WAVE and AChecker tool. Travatan Z® had the highest number of errors of 117 according to WAVE and Durysta™ had the greatest number of 42 problems based on the AChecker tool. The types of errors categorized by the POUR principles are provided in Table 1 and Table 2 . The common types of errors or problems identified based on the POUR principles were lack of alternative text (Guideline 1.1), not making content easier for users to hear including separation of foreground and background (Guideline 1.4), lack of navigational help for users to find content or determine where they are on the webpage (Guideline 2.3), and not maximizing compatibility with assistive technologies (Guideline 4.1). The WCAG 2.0 conformance levels had the most errors at Level A and AA. The specific errors and problems identified within by each tool are highlighted in Tables 3 and 4 . As per the WAVE tool, the Tepezza® website had the most errors related to structural elements and use of ARIA. Travatan Z® also had the highest number of errors related to contrast and features while both of the Vyzulta® and the Rhopressa® websites had the lowest number of errors. There were more known or likely problems identified by AChecker for all of the websites than the potential problems that require a human check and may not present as in actual issue. Tepezza® had the most problems which was consistent with the WAVE tool; although, Travatan Z® had the fewest problems. Table 1 Types of Errors Identified by WAVE For Each Drug Product Website Errors, No.(%) Contrast Errors No.(%) Alerts No.(%) Features No.(%) Structural Elements No.(%) ARIA No.(%) Total Alphagan P® 12 (13.9%) 21 (24.4%) 17 (19.7%) 13 (15.1%) 19 (22%) 4 (4.6%) 86 Combigan® 9 (13.4%) 9 (13.4%) 18 (26.8%) 12 (17.9%) 15 (22.4%) 4 (5.9%) 67 Durysta™ 5 (4%) 11 (8.9%) 25 (20.2%) 42 (33.9%) 28 (22.6%) 13 (10.4%) 124 Lumigan® 10 (11.8%) 28 (32.9%) 15 (17.6%) 12 (14.1%) 16 (18.8%) 4 (4.7%) 85 Luxturna™ 2 (2.5%) 2 (2.5%) 24 (30.4%) 9 (11.4%) 24 (30.4%) 18 (22.8%) 79 Rhopressa® 0 2 (6.4%) 8 (25.8%) 3 (9.7%) 18 (58%) 0 69 Rocklatan® 0 2 (3.6%) 36 (64.3%) 4 (7.2%) 14 (25%) 0 56 Tepezza® 10 (3.4%) 0 30 (10.3%) 24 (8.2%) 62 (21.2%) 166 (56.8%) 292 Travatan Z® 13 (6.3%) 50 (24.3%) 21 (10.2%) 88 (42.7%) 34 (16.5%) 0 206 Vyzulta® 0 0 5 (14.3%) 12 (34.3%) 13 (37.1%) 5 (14.3%) 35 Xalatan® 2 (2.8%) 15 (21.4%) 18 (25.7%) 16 (22.8%) 17 (24.3%) 2 (2.8%) 70 Alerts = text format for audio or video files; Features = alternative text for images; Structural elements = may include headings, options for users to navigate through the website; ARIA = provides enhanced semantics and accessibility for web content Table 2 Types of Problems of Drug Product Websites Identified by AChecker Known Problems, No.(%) Likely Problems No.(%) Potential Problems No.(%) Total Alphagan P® 11 (3.9%) 38 (17.3%) 171 (77.7%) 220 (100%) Combigan® 17 (7.4%) 44 (19.2%) 168 (73.4%) 229 (100%) Durysta™ 42 (9.7%) 34 (7.8%) 357 (82.4%) 433 (100%) Lumigan® 11 (5.2%) 39 (18.6%) 160 76.2%) 210 (100%) Luxturna™ 11 (5.4%) 56 (27.4%) 137 (67.1%) 204 (100%) Rhopressa® 12 (13%) 18 (19.6%) 62 (67.4%) 92 (100%) Rocklatan® 0 16 (21%) 60 (79%) 76 (100%) Tepezza® 12 (2.7%) 86 (19.1%) 351 (78.2%) 449 (100%) Travatan Z® 9 (1.4%) 11 (1.7%) 627 (96.9%) 647 (100%) Vyzulta® 0 29 (13.6%) 184 (86.4%) 213 (100%) Xalatan® 28 (12.3%) 51 (22.5%) 148 (65.2%) 227 (100%) Known = certain accessibility barriers that should be resolved; Likely = probable barriers that require human decision; Potential = AChecker unable to identify problems, requiring a human check. Table 3 Total Errors for All Websites (N = 11) Identified by WAVE Based on POUR Principles WCAG 2.0 Level A WCAG 2.0 Level AA WCAG 2.0 Level AAA Perceivable (Principle 1) 1.1 Text Alternatives: Provide text alternatives for any non-text content 316 0 0 1.2 Time-based Media: Provide alternatives for time-based media 0 0 0 1.3 Adaptable: Create content that can be presented in different ways without losing information or structure. 137 0 0 1.4 Distinguishable: Make it easier for users to see and hear content including separating foreground from background. 0 138 0 Operable (Principle 2) 2.1 Keyboard Accessible: Make all functionalities available from a keyboard. 127 0 0 2.2 Enough Time: Provide users enough time to read and use content. 0 0 0 2.3 Seizures: Do not design content in a way that is known to cause seizures. 0 0 0 2.4 Navigable: Provide ways to help users navigate, find content, and determine where they are. 177 134 0 Understandable (Principle 3) 3.1 Readable: Make text content readable and understandable. 5 0 0 3.2 Predictable: Make web pages appear and operate in predictable ways. 0 0 0 3.3 Input Assistance: Help users avoid and correct mistakes. 9 0 0 Robust (Principle 4) 4.1 Compatible: Maximize compatibility with current and future user agents, including assistive technologies. 90 1 0 Level A = low conformance, Level AA = moderate conformance, Level AAA = high conformance Table 4 Total Problems for All Websites(N = 11) Identified by AChecker Based on POUR Principles WCAG 2.0 Level A WCAG 2.0 Level AA WCAG 2.0 Level AAA Perceivable (Principle 1) 1.1 Text Alternatives: Provide text alternatives for any non-text content 32 0 0 1.2 Time-based Media: Provide alternatives for time-based media 0 0 0 1.3 Adaptable: Create content that can be presented in different ways without losing information or structure 9 0 0 1.4 Distinguishable: Make it easier for users to see and hear content including separating foreground from background 0 41 24 Operable (Principle 2) 2.1 Keyboard Accessible: Make all functionalities available from a keyboard 0 0 0 2.2 Enough Time: Provide users enough time to read and use content 0 0 0 2.3 Seizures: Do not design content in a way that is known to cause seizures 0 0 0 2.4 Navigable: Provide ways to help users navigate, find content, and determine where they are 15 14 0 Understandable (Principle 3) 3.1 Readable: Make text content readable and understandable 7 0 0 3.2 Predictable: Make web pages appear and operate in predictable ways 0 0 0 3.3 Input Assistance: Help users avoid and correct mistakes 5 0 0 Robust (Principle 4) 4.1 Compatible: Maximize compatibility with current and future user agents, including assistive technologies 6 0 0 Level A = low conformance, Level AA = moderate conformance, Level AAA = high conformance After evaluation of accessibility using the AChecker and WAVE, JAWS® was used to read through the content of each of the websites to verify issue or identify additional ones that consumers may encounter. Some of the common issues were consistent with the evaluation tools found including lack of alternative text for images (e.g., logos, graphs, quotes), no description for links, and drop-down menus do not expand using the keyboard functions. Discussion When conducting a search for information about a drug, the product website is among one of the first results that appear on search engines. Nearly one in four people live with a disability in the U.S.; therefore, there is a high likelihood that consumers with visual disabilities may navigate to the website for drug information [ 17 ]. It is imperative that pharmaceutical companies build websites that are also accessible to individuals with visual disabilities who may use a screen reader. All product websites evaluated in this study had errors or problems identified by both evaluation tools and showed nonconformance to WCAG 2.0 and 2.1 guidelines at different levels similar to results found in previous studies [ 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 ]. The Rhopressa® and Rocklatan® product websites had the lowest number of errors which may indicate that individuals with disabilities can interact with most of content on these websites but may still encounter some accessibility issues. Based on the POUR principles, violations of Guideline 1.1 identified by AChecker and WAVE were often at Level A due to the lack of alternative text for non-text content such as images, videos, and figures. A potential modification may include providing a text alternative describing the image or figure so that a screen reader may be able to read the text to the user. Guideline 2.3 also had violations at Level A and AA which suggests that users may need more help with navigating through the website and finding content. Web developers may include skip links, section headings to organize content, and page titles to address these violations. Lastly, Guideline 4.1 had violations at Level A; therefore, these websites will need to ensure that users must be able to access the content as technologies advance specifically those using assistive technologies. Overall, commercial websites created by the pharmaceutical companies have been recommended to design a simple and basic layout and schematic of the websites to increase greater accessibility [ 12 ]. During the development process, manufacturers may also implement a user-based approach by recruiting end users to test the accessibility of the content associated with the website [ 18 ]. In addition to the design, manufacturers may also consider including an accessibility policy provided on the website similar to Vanda’s Hetlioz® product website. Hetlioz® is a product approved for non-24 sleep wake disorder which impact mostly patients with blindness and the product website was created based on the manufacturer’s accessibility policy. The product website includes enhancements that promote accessibility for individuals with blindness and visuals were adapted for sighted people such as caregivers, family, and doctors, and an auditory version of the prescribing information [ 19 ]. There were several limitations in this study. Only websites pertinent to ocular products were evaluated. Future studies may expand evaluation of drug products that are commonly used or prescribed as individuals with visual impairment and/or blindness are not limited to taking the class of drugs featured in this study. There were only two evaluation tools used in this study to assess accessibility of websites. Use of other tools may offer a different perspective on accessibility and account for issues missed by other evaluation tools. This study also evaluated the main page of the websites and did not navigate into the various subdivisions of the other webpages. Future studies are needed to determine the digital inclusiveness of drug product websites on mobile devices and the accessibility of the content for this population. The findings of the study highlight the need for manufacturers to improve accessibility of product websites to ensure important drug information is available to this patient population. It has been recommended for web developers to learn about web accessibility standards and legislation related to accessibility to build websites that allow for all users including those with visual disabilities who use assistive technologies to interact with the content and to include end users during the development process [ 5 , 16 ]. Until the accessibility of these websites can be improved, manufacturers may provide content in alternative formats as part of the accessibility policy on the website or make this option available to those who may need it similar to Vanda’s Hetlioz® product website. It is prudent for pharmacists and other healthcare professionals to provide education about drugs through counseling to individuals with visual impairment or disabilities. In addition, health information professionals and health sciences librarians can provide resources on accessibility to educate healthcare professionals so it becomes a mainstay in clinical practice. Declarations Funding All authors do not have any funding sources to report. Competing Interests: All authors do not have any potential or actual conflict of interests to declare. Author Contribution All listed authors, Cambrey Nguyen and Kristin Villa, made substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data; or the creation of new software used in the work; drafted the work or revised it critically for important intellectual content; approved the version to be published; and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. Data Availability All data supporting the findings of this study are available at an online repository: Web Accessibility Data (https://iowa-my.sharepoint.com/:f:/g/personal/cbnguyen_uiowa_edu/ElUCpOJhVn5IhamwIw11kcgBbWS1i09EHSsF2C-D7WzK3A?e=ZS3z7P). Data Availability Statement Data associated with this article are available in the One Drive SharePoint website available at https://kansasmy.sharepoint.com/:f:/g/personal/cnguyen_home_ku_edu/EiKn-wTEgddNnnPm3rUg9OABi46LT8VRrybW8Bo0pZUWDg?e=B23Fej References InternetLiveStats: Google search statistics [Internet]. InternetLiveStats [rev. ; cited February 2021]. (2021). http://www.internetlivestats.com/google-search-statistics/. Pew Research Center: Health online 2013 [Internet]. The Center; Jan 2013 [cited 22 December 2022]. https://www.pewresearch.org/internet/2013/01/15/health-online-2013/ Web Accessibility Initiative. Web Content Accessibility Guidelines (WCAG) Overview [Internet]. Web Accessibility Initiative (WAI): [cited 20 December 2022]. (2022). https://www.w3.org/WAI/standards-guidelines/wcag/ Olalere, A., Lazar, J.: Accessibility of US federal government home pages: section 508 compliance and site accessibility statements. Gov. Inf. 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Cite Share Download PDF Status: Published Journal Publication published 16 Jul, 2024 Read the published version in Universal Access in the Information Society → Version 1 posted Reviews received at journal 29 Jun, 2024 Reviewers agreed at journal 29 Jun, 2024 Reviewers invited by journal 28 May, 2024 Editor assigned by journal 28 May, 2024 Submission checks completed at journal 21 May, 2024 First submitted to journal 09 May, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4396551","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Short Report","associatedPublications":[],"authors":[{"id":309633147,"identity":"19f17ad9-d942-4c0e-8681-a7e726ac7ebc","order_by":0,"name":"Cambrey Nguyen","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABAElEQVRIiWNgGAWjYHACNmSODYzLTLSWNNK1HIYxcGvhbz+d9rii4jCDOf8aM4mPO84n9rH3GH5gqLBObMChReJM7nbDM2cOM1jOeGMmOfPM7cQ2njPGEgxn0nFqMWDI3SbZ2Ha4fsONM2bSvG1ALRK5GyQY2w7j1sL/Fqjl32EGA5CWv23nQFo2/2D8h0eLBMiWBqCW8z1m0oxtB0BatkkwNuDWInHj7XbDhmPpQFvYii1725KN23jOf7NIOJZujEsLf3/utocNNdZAWw5vvPGzzU52fntb8o0PNdayuLRAQTPQvgQWCTg/Ab9yEKgD2neA+QNhhaNgFIyCUTASAQC+SV65LXifzwAAAABJRU5ErkJggg==","orcid":"","institution":"University of Iowa College of Pharmacy","correspondingAuthor":true,"prefix":"","firstName":"Cambrey","middleName":"","lastName":"Nguyen","suffix":""},{"id":309633148,"identity":"8b0b467e-4255-4a10-ab57-290fdcfc4181","order_by":1,"name":"Kristin Villa","email":"","orcid":"","institution":"University of Missouri–Kansas City","correspondingAuthor":false,"prefix":"","firstName":"Kristin","middleName":"","lastName":"Villa","suffix":""}],"badges":[],"createdAt":"2024-05-09 17:21:15","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4396551/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4396551/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1007/s10209-024-01134-x","type":"published","date":"2024-07-16T16:05:17+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":61595104,"identity":"3d644ba4-6812-4df1-bb1b-075681cb8f40","added_by":"auto","created_at":"2024-08-01 17:20:05","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":553837,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4396551/v1/ce928403-29f9-4609-ba14-188333c13f5b.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eAccessibility of Drug Information on Ocular Drug Product Websites in the United States\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eThe internet is a commonly used resource for consumers to find drug information because of ease of use and convenience; however, accessibility of websites for individuals with visual impairment or blindness may not be considered [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Accessibility includes a range of disabilities including physical, auditory, cognitive, language, learning, speech, and neurological disabilities [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Section 508 of the Rehabilitation Act Amendments and Section 225 of the Telecommunications Act of 1996 describe web accessibility standards for federal or government websites [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Web accessibility is defined as making websites usable for people with disabilities to navigate and interact with content while using assistive technology such as a screen reader [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. In the literature, studies have shown public health websites including the U.S., Korea, Iberia, and Canada remains at a low conformance level to accessibility guidelines or standards which present significant issues for individuals with disabilities in obtaining important health information from government officials [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Other studies have also assessed the accessibility of COVID-19 vaccine registration websites and health information.\u003c/p\u003e \u003cp\u003eA recent study evaluated the accessibility of 54 official COVID-19 vaccine registration websites using the POUR framework from the most recent Web Content Accessibility Guidelines (WCAG 2.0, 2.1) published by the World Wide Web Consortium (W3C). The study found up to five state registration websites \u0026ldquo;passed\u0026rdquo; by having zero errors identified by the WAVE, AChecker, and SortSite evaluation tools. This study highlighted the majority of the vaccine registration websites were not compliant with accessibility guidelines and state authorities should improve accessibility to ensure that individuals with disabilities can schedule vaccine appointments [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Two studies assessed the accessibility of health information found in popular websites. One study evaluated 108 consumer health information websites using the number of violations of Web Accessibility Barrier checkpoints. None of the Web sites evaluated were completely accessible to people with disabilities as every website consisted of at least one violation of Web accessibility rules. Government and educational health information Web sites had less violations compared to other websites [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Another study assessed accessibility of 138 websites featuring disease state information using a checklist of Checkpoints for Web Content Accessibility Guidelines 1.0. This study showed that not even one fifth of all web sites containing health information evaluated meets the minimal requirements of accessibility according to the WAI guidelines (priority 1/level A). For this reason, the information presented can be accessed only partially or not at all by users with visually impairment or blindness [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe objective of this study is to build on previous studies by evaluating the accessibility of manufacturers\u0026rsquo; website featuring drug information on ocular products using two accessibility checkers.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThe drugs included in the analysis for this study were obtained from drug class overviews found in tertiary databases (e.g., Clinical Pharmacology and Micromedex) and a published review on ocular products [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Patients with ophthalmic diseases are likely to have reduced visual acuity or another visual impairment. The list initially consisted of 20 drugs; however, there were only 11 drugs that had a drug product website. The drugs included in the final analysis are as follows: Alphagan P\u0026reg;, Travatan Z\u0026reg;, Lumigan\u0026reg;, Rhopressa\u0026reg;, Vyzulta\u0026reg;, Combigan\u0026reg;, Rocklatan\u0026reg;, Tepezza\u0026reg;, Luxturna\u0026trade;, Durysta\u0026trade;, Xalatan\u0026reg;.\u003c/p\u003e \u003cp\u003eThe accessibility of each drug product homepage was evaluated based on the World Wide Web Consortium's (W3C) Web Content Accessibility Guidelines (WCAG). The WCAG 2.0 was originally published in 2008 then was revised to version 2.1 in 2018. The WCAG 2.1 version has 12 guidelines, and 78 success criteria consisting of 61 success criteria from WCAG 2.0 and 17 new success criteria relevant to mobile devices and visual and cognitive impairment. The 12 guidelines are based on the POUR principles of 1) Perceivable-information and user interface components must be presentable to users in ways they can perceive; 2) Operable-user interface components and navigation must be operable; 3) Understandable-information and the operation of the user interface must be understandable; and 4) Robust-content must be robust enough that it can be interpreted reliably by a wide variety of user agents, including assistive technologies. Each of these guidelines have success criteria that determine conformance to WCAG and are based on a three-compliance levels: Level AAA (highest conformance), Level AA (intermediate conformance), level A (minimal conformance). Moreover, the conformance level determines the extent to which a website follows the accessibility guidelines. Content compliant with WCAG 2.1 would also comply with WCAG 2.0 standards.\u003c/p\u003e \u003cp\u003eTwo free tools, WAVE and AChecker, were used to evaluate website accessibility according to WCAG and have been used in previous studies that assessed health-related websites. WAVE was created by WebAIM in 2001 and provides color-coded icons to enable testers to check for possible accessibility problems on a web page using a color-coded system. The red icons designate accessibility and contrast errors; yellow is related to accessibility problems (alerts) where human judgment is needed; green define features that improve accessibility when implemented properly; blue icons speak to structural, navigational, or semantic elements; purple showcases the use of ARIA within a webpage which provides enhanced semantics and accessibility for web content but older browsers and assistive technologies may not support this feature. WAVE was used to assess the web accessibility of the selected drug websites against the WCAG 2.1 standard [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAChecker is the most commonly used tool for WCAG 2.0 verification and provides three categories of problems: \u0026ldquo;known\u0026rdquo; refers to certain accessibility barriers that should be resolved, \u0026ldquo;likely\u0026rdquo; designates probable barriers that require human decision, and \u0026ldquo;potential\u0026rdquo; designates AChecker is unable to identify problems, requiring a human check [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Testing of each product website using these two tools were conducted in October 2021 and all webpages were analyzed using the website (URL) links. Job Access with Speech (JAWS\u0026reg;) screen reader was then utilized to read through the content presented on the homepage of each product website. This software was chosen as it is among one of the most commonly used screen readers for Windows devices and allows for users that are blind or visually impaired to read the text displayed on the computer screen with a speech synthesizer [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. JAWS was then used to confirm any errors or alerts found by two accessibility checkers. Descriptive statistics (percentages) were used to present the errors and problems identified by both tools.\u003c/p\u003e \u003cp\u003eIRB oversight was provided by the University of Kansas Human Research Protection Program for this study.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eAll websites had varying number of errors and problems based on the WAVE and AChecker tool. Travatan Z\u0026reg; had the highest number of errors of 117 according to WAVE and Durysta\u0026trade; had the greatest number of 42 problems based on the AChecker tool. The types of errors categorized by the POUR principles are provided in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e and Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. The common types of errors or problems identified based on the POUR principles were lack of alternative text (Guideline 1.1), not making content easier for users to hear including separation of foreground and background (Guideline 1.4), lack of navigational help for users to find content or determine where they are on the webpage (Guideline 2.3), and not maximizing compatibility with assistive technologies (Guideline 4.1). The WCAG 2.0 conformance levels had the most errors at Level A and AA. The specific errors and problems identified within by each tool are highlighted in Tables\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e and \u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e. As per the WAVE tool, the Tepezza\u0026reg; website had the most errors related to structural elements and use of ARIA. Travatan Z\u0026reg; also had the highest number of errors related to contrast and features while both of the Vyzulta\u0026reg; and the Rhopressa\u0026reg; websites had the lowest number of errors. There were more known or likely problems identified by AChecker for all of the websites than the potential problems that require a human check and may not present as in actual issue. Tepezza\u0026reg; had the most problems which was consistent with the WAVE tool; although, Travatan Z\u0026reg; had the fewest problems.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eTypes of Errors Identified by WAVE For Each Drug Product Website\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eErrors, No.(%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eContrast Errors No.(%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAlerts No.(%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eFeatures No.(%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eStructural Elements No.(%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eARIA No.(%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAlphagan P\u0026reg;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12 (13.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21 (24.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e17 (19.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e13 (15.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e19 (22%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e4 (4.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e86\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCombigan\u0026reg;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9 (13.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9 (13.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e18 (26.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e12 (17.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e15 (22.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e4 (5.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e67\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDurysta\u0026trade;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 (4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11 (8.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e25 (20.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e42 (33.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e28 (22.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e13 (10.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e124\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLumigan\u0026reg;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10 (11.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28 (32.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e15 (17.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e12 (14.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e16 (18.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e4 (4.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e85\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLuxturna\u0026trade;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (2.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (2.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e24 (30.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e9 (11.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e24 (30.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e18 (22.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e79\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRhopressa\u0026reg;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (6.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e8 (25.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3 (9.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e18 (58%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e69\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRocklatan\u0026reg;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (3.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e36 (64.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e4 (7.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e14 (25%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e56\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTepezza\u0026reg;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10 (3.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e30 (10.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e24 (8.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e62 (21.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e166 (56.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e292\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTravatan Z\u0026reg;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13 (6.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e50 (24.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e21 (10.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e88 (42.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e34 (16.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e206\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVyzulta\u0026reg;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5 (14.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e12 (34.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e13 (37.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e5 (14.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eXalatan\u0026reg;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (2.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15 (21.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e18 (25.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e16 (22.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e17 (24.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2 (2.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e70\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"8\"\u003eAlerts\u0026thinsp;=\u0026thinsp;text format for audio or video files; Features\u0026thinsp;=\u0026thinsp;alternative text for images; Structural elements\u0026thinsp;=\u0026thinsp;may include headings, options for users to navigate through the website; ARIA\u0026thinsp;=\u0026thinsp;provides enhanced semantics and accessibility for web content\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eTypes of Problems of Drug Product Websites Identified by AChecker\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eKnown Problems, No.(%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eLikely Problems\u003c/p\u003e \u003cp\u003eNo.(%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePotential Problems\u003c/p\u003e \u003cp\u003eNo.(%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAlphagan P\u0026reg;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e11\u003c/p\u003e \u003cp\u003e(3.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e38\u003c/p\u003e \u003cp\u003e(17.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e171\u003c/p\u003e \u003cp\u003e(77.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e220 (100%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCombigan\u0026reg;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e17\u003c/p\u003e \u003cp\u003e(7.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e44\u003c/p\u003e \u003cp\u003e(19.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e168\u003c/p\u003e \u003cp\u003e(73.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e229 (100%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDurysta\u0026trade;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e42\u003c/p\u003e \u003cp\u003e(9.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e34\u003c/p\u003e \u003cp\u003e(7.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e357\u003c/p\u003e \u003cp\u003e(82.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e433 (100%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLumigan\u0026reg;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e11\u003c/p\u003e \u003cp\u003e(5.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e39\u003c/p\u003e \u003cp\u003e(18.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e160\u003c/p\u003e \u003cp\u003e76.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e210 (100%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLuxturna\u0026trade;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e11\u003c/p\u003e \u003cp\u003e(5.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e56\u003c/p\u003e \u003cp\u003e(27.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e137\u003c/p\u003e \u003cp\u003e(67.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e204 (100%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRhopressa\u0026reg;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e12\u003c/p\u003e \u003cp\u003e(13%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e18\u003c/p\u003e \u003cp\u003e(19.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e62\u003c/p\u003e \u003cp\u003e(67.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e92 (100%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRocklatan\u0026reg;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e16\u003c/p\u003e \u003cp\u003e(21%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e60\u003c/p\u003e \u003cp\u003e(79%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e76 (100%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTepezza\u0026reg;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e12\u003c/p\u003e \u003cp\u003e(2.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e86\u003c/p\u003e \u003cp\u003e(19.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e351\u003c/p\u003e \u003cp\u003e(78.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e449 (100%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTravatan Z\u0026reg;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e9\u003c/p\u003e \u003cp\u003e(1.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e11\u003c/p\u003e \u003cp\u003e(1.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e627\u003c/p\u003e \u003cp\u003e(96.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e647 (100%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVyzulta\u0026reg;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e29\u003c/p\u003e \u003cp\u003e(13.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e184\u003c/p\u003e \u003cp\u003e(86.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e213 (100%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eXalatan\u0026reg;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e28\u003c/p\u003e \u003cp\u003e(12.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e51\u003c/p\u003e \u003cp\u003e(22.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e148\u003c/p\u003e \u003cp\u003e(65.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e227 (100%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eKnown\u0026thinsp;=\u0026thinsp;certain accessibility barriers that should be resolved; Likely\u0026thinsp;=\u0026thinsp;probable barriers that require human decision; Potential\u0026thinsp;=\u0026thinsp;AChecker unable to identify problems, requiring a human check.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eTotal Errors for All Websites (N\u0026thinsp;=\u0026thinsp;11) Identified by WAVE Based on POUR Principles\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWCAG 2.0 Level A\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eWCAG 2.0 Level AA\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eWCAG 2.0\u003c/p\u003e \u003cp\u003eLevel AAA\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePerceivable (Principle 1)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1.1 Text Alternatives: Provide text alternatives for any non-text content\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e316\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1.2 Time-based Media: Provide alternatives for time-based media\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1.3 Adaptable: Create content that can be presented in different ways without losing information or structure.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e137\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1.4 Distinguishable: Make it easier for users to see and hear content including separating foreground from background.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e138\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOperable (Principle 2)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2.1 Keyboard Accessible: Make all functionalities available from a keyboard.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e127\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2.2 Enough Time: Provide users enough time to read and use content.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2.3 Seizures: Do not design content in a way that is known to cause seizures.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2.4 Navigable: Provide ways to help users navigate, find content, and determine where they are.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e177\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e134\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eUnderstandable (Principle 3)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3.1 Readable: Make text content readable and understandable.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3.2 Predictable: Make web pages appear and operate in predictable ways.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3.3 Input Assistance: Help users avoid and correct mistakes.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eRobust (Principle 4)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4.1 Compatible: Maximize compatibility with current and future user agents, including assistive technologies.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003eLevel A\u0026thinsp;=\u0026thinsp;low conformance, Level AA\u0026thinsp;=\u0026thinsp;moderate conformance, Level AAA\u0026thinsp;=\u0026thinsp;high conformance\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eTotal Problems for All Websites(N\u0026thinsp;=\u0026thinsp;11) Identified by AChecker Based on POUR Principles\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWCAG 2.0 Level A\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eWCAG 2.0 Level AA\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eWCAG 2.0 Level AAA\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePerceivable (Principle 1)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1.1 Text Alternatives: Provide text alternatives for any non-text content\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1.2 Time-based Media: Provide alternatives for time-based media\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1.3 Adaptable: Create content that can be presented in different ways without losing information or structure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1.4 Distinguishable: Make it easier for users to see and hear content including separating foreground from background\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOperable (Principle 2)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2.1 Keyboard Accessible: Make all functionalities available from a keyboard\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2.2 Enough Time: Provide users enough time to read and use content\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2.3 Seizures: Do not design content in a way that is known to cause seizures\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2.4 Navigable: Provide ways to help users navigate, find content, and determine where they are\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eUnderstandable (Principle 3)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3.1 Readable: Make text content readable and understandable\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3.2 Predictable: Make web pages appear and operate in predictable ways\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3.3 Input Assistance: Help users avoid and correct mistakes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eRobust (Principle 4)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4.1 Compatible: Maximize compatibility with current and future user agents, including assistive technologies\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003eLevel A\u0026thinsp;=\u0026thinsp;low conformance, Level AA\u0026thinsp;=\u0026thinsp;moderate conformance, Level AAA\u0026thinsp;=\u0026thinsp;high conformance\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eAfter evaluation of accessibility using the AChecker and WAVE, JAWS\u0026reg; was used to read through the content of each of the websites to verify issue or identify additional ones that consumers may encounter. Some of the common issues were consistent with the evaluation tools found including lack of alternative text for images (e.g., logos, graphs, quotes), no description for links, and drop-down menus do not expand using the keyboard functions.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eWhen conducting a search for information about a drug, the product website is among one of the first results that appear on search engines. Nearly one in four people live with a disability in the U.S.; therefore, there is a high likelihood that consumers with visual disabilities may navigate to the website for drug information [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. It is imperative that pharmaceutical companies build websites that are also accessible to individuals with visual disabilities who may use a screen reader. All product websites evaluated in this study had errors or problems identified by both evaluation tools and showed nonconformance to WCAG 2.0 and 2.1 guidelines at different levels similar to results found in previous studies [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. The Rhopressa\u0026reg; and Rocklatan\u0026reg; product websites had the lowest number of errors which may indicate that individuals with disabilities can interact with most of content on these websites but may still encounter some accessibility issues. Based on the POUR principles, violations of Guideline 1.1 identified by AChecker and WAVE were often at Level A due to the lack of alternative text for non-text content such as images, videos, and figures. A potential modification may include providing a text alternative describing the image or figure so that a screen reader may be able to read the text to the user. Guideline 2.3 also had violations at Level A and AA which suggests that users may need more help with navigating through the website and finding content. Web developers may include skip links, section headings to organize content, and page titles to address these violations. Lastly, Guideline 4.1 had violations at Level A; therefore, these websites will need to ensure that users must be able to access the content as technologies advance specifically those using assistive technologies. Overall, commercial websites created by the pharmaceutical companies have been recommended to design a simple and basic layout and schematic of the websites to increase greater accessibility [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. During the development process, manufacturers may also implement a user-based approach by recruiting end users to test the accessibility of the content associated with the website [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. In addition to the design, manufacturers may also consider including an accessibility policy provided on the website similar to Vanda\u0026rsquo;s Hetlioz\u0026reg; product website. Hetlioz\u0026reg; is a product approved for non-24 sleep wake disorder which impact mostly patients with blindness and the product website was created based on the manufacturer\u0026rsquo;s accessibility policy. The product website includes enhancements that promote accessibility for individuals with blindness and visuals were adapted for sighted people such as caregivers, family, and doctors, and an auditory version of the prescribing information [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThere were several limitations in this study. Only websites pertinent to ocular products were evaluated. Future studies may expand evaluation of drug products that are commonly used or prescribed as individuals with visual impairment and/or blindness are not limited to taking the class of drugs featured in this study. There were only two evaluation tools used in this study to assess accessibility of websites. Use of other tools may offer a different perspective on accessibility and account for issues missed by other evaluation tools. This study also evaluated the main page of the websites and did not navigate into the various subdivisions of the other webpages. Future studies are needed to determine the digital inclusiveness of drug product websites on mobile devices and the accessibility of the content for this population.\u003c/p\u003e \u003cp\u003eThe findings of the study highlight the need for manufacturers to improve accessibility of product websites to ensure important drug information is available to this patient population. It has been recommended for web developers to learn about web accessibility standards and legislation related to accessibility to build websites that allow for all users including those with visual disabilities who use assistive technologies to interact with the content and to include end users during the development process [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Until the accessibility of these websites can be improved, manufacturers may provide content in alternative formats as part of the accessibility policy on the website or make this option available to those who may need it similar to Vanda\u0026rsquo;s Hetlioz\u0026reg; product website. It is prudent for pharmacists and other healthcare professionals to provide education about drugs through counseling to individuals with visual impairment or disabilities. In addition, health information professionals and health sciences librarians can provide resources on accessibility to educate healthcare professionals so it becomes a mainstay in clinical practice.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003eAll authors do not have any funding sources to report.\u003c/p\u003e \u003ch2\u003eCompeting Interests:\u003c/strong\u003e \u003cp\u003eAll authors do not have any potential or actual conflict of interests to declare.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eAll listed authors, Cambrey Nguyen and Kristin Villa, made substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data; or the creation of new software used in the work; drafted the work or revised it critically for important intellectual content; approved the version to be published; and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eAll data supporting the findings of this study are available at an online repository: Web Accessibility Data (https://iowa-my.sharepoint.com/:f:/g/personal/cbnguyen_uiowa_edu/ElUCpOJhVn5IhamwIw11kcgBbWS1i09EHSsF2C-D7WzK3A?e=ZS3z7P).\u003c/p\u003e\n\u003ch3\u003eData Availability Statement\u003c/h3\u003e\n\u003cp\u003eData associated with this article are available in the One Drive SharePoint website available at \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://kansasmy.sharepoint.com/:f:/g/personal/cnguyen_home_ku_edu/EiKn-wTEgddNnnPm3rUg9OABi46LT8VRrybW8Bo0pZUWDg?e=B23Fej\u003c/span\u003e\u003cspan address=\"https://kansasmy.sharepoint.com/:f:/g/personal/cnguyen_home_ku_edu/EiKn-wTEgddNnnPm3rUg9OABi46LT8VRrybW8Bo0pZUWDg?e=B23Fej\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eInternetLiveStats: Google search statistics [Internet]. 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Soc. \u003cb\u003e19\u003c/b\u003e(1), 41\u0026ndash;56 (2020). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s10209-018-0625-5\u003c/span\u003e\u003cspan address=\"10.1007/s10209-018-0625-5\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMartins, J., Gon\u0026ccedil;alves, R., Branco, F., Pereira, J., Peixoto, C., Rocha, T.: How Ill Is Online Health Care? An Overview on the Iberia Peninsula Health Care Institutions Websites Accessibility Levels. In: Rocha, \u0026Aacute;., Correia, A., Adeli, H., Reis, L., Mendon\u0026ccedil;a Teixeira, M. (eds.) New Advances in Information Systems and Technologies. Advances in Intelligent Systems and Computing, vol. 445. Springer, Cham (2016)\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eO'Grady, L.: Accessibility compliance rates of consumer-oriented Canadian health care Web sites. Med Inform Internet Med. ;30(4):287\u0026thinsp;\u0026ndash;\u0026thinsp;95. doi: 10.1080/14639230500367746. PMID: 16531355. (2005)\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAlismail, S., Chipidza, W.: Accessibility evaluation of COVID-19 vaccine registration websites across the United States. J. Am. Med. Inf. Assoc. \u003cb\u003e28\u003c/b\u003e(9), 1990\u0026ndash;1995 (2021). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1093/jamia/ocab105\u003c/span\u003e\u003cspan address=\"10.1093/jamia/ocab105\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e PMID: 33993310; PMCID: PMC8244541\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZeng, X., Parmanto, B.: Web content accessibility of consumer health information web sites for people with disabilities: a cross sectional evaluation. J. Med. Internet Res. \u003cb\u003e6\u003c/b\u003e(2), e19 (2004). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.2196/jmir.6.2.e19\u003c/span\u003e\u003cspan address=\"10.2196/jmir.6.2.e19\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e PMID: 15249268; PMCID: PMC1550595\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eL\u0026uuml;chtenberg, M., Kuhli-Hattenbach, C., Sinangin, Y., Ohrloff, C., Schalnus, R.: Accessibility of health information on the internet to the visually impaired user. Ophthalmologica. \u003cb\u003e222\u003c/b\u003e(3), 187\u0026ndash;193 (2008). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1159/000126082\u003c/span\u003e\u003cspan address=\"10.1159/000126082\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e Epub 2008 May 22. PMID: 18497528\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLorenzo-Veiga, B., Alvarez-Lorenzo, C., Loftsson, T., Sigurdsson, H.H.: Age-related ocular conditions: Current treatments and role of cyclodextrin-based nanotherapies. Int. J. Pharm. \u003cb\u003e603\u003c/b\u003e, 120707 (2021). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.ijpharm.2021.120707\u003c/span\u003e\u003cspan address=\"10.1016/j.ijpharm.2021.120707\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e Epub 2021 May 13. PMID: 33991594\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWAVE: WAVE Web Accessibility Evaluation Tool [Internet]; [cited 20 December 2022]. (2022). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://wave.webaim.org/\u003c/span\u003e\u003cspan address=\"https://wave.webaim.org/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAChecker: IDI Web Accessibility Checker: Web Accessibility Checker [Internet]; [cited 20 December 2022]. (2022). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://achecker.ca/checker/index.php\u003c/span\u003e\u003cspan address=\"https://achecker.ca/checker/index.php\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFreedom Scientific: JAWS Product Overview [Internet]; [cited 20 December 2022]. (2022). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.freedomscientific.com/products/software/jaws\u003c/span\u003e\u003cspan address=\"https://www.freedomscientific.com/products/software/jaws\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCenter for Disease Control: CDC: 1 in 4 US adults live with a disability [Internet]; [cited 20 December 2022]. (2022). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.cdc.gov/media/releases/2018/p0816-disability.html\u003c/span\u003e\u003cspan address=\"https://www.cdc.gov/media/releases/2018/p0816-disability.html\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYeong, J.L., Thomas, P., Buller, J., Moosajee, M.: A newly developed web-based resource on genetic eye disorders for users with visual impairment (Gene.Vision): Usability study [published correction appears in \u003cem\u003eJ Med Internet Res\u003c/em\u003e. ;23(1):e27330]. \u003cem\u003eJ Med Internet Res\u003c/em\u003e. 2021;23(1):e19151. Published 2021 Jan 20. (2021). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.2196/19151\u003c/span\u003e\u003cspan address=\"10.2196/19151\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVanda Pharmaceuticals: Accessibility Policy [Internet]; [cited 20 December 2022]. (2022). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://hetlioz.com/accessibilitypolicy\u003c/span\u003e\u003cspan address=\"https://hetlioz.com/accessibilitypolicy\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"universal-access-in-the-information-society","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"uais","sideBox":"Learn more about [Universal Access in the Information Society](http://link.springer.com/journal/10209)","snPcode":"10209","submissionUrl":"https://submission.nature.com/new-submission/10209/3","title":"Universal Access in the Information Society","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"disability, screen reader, drug resource, web accessibility, pharmaceutical industry","lastPublishedDoi":"10.21203/rs.3.rs-4396551/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4396551/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003ePurpose\u003c/h2\u003e \u003cp\u003eThe internet is a drug information resource for consumers because of ease of use and convenience; however, accessibility for individuals with visual impairment is often not considered. Previous studies found pharmaceutical websites did not meet accessibility standards. This study builds on previous research by evaluating accessibility of prescription ocular drug product websites using two accessibility checkers.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eTwenty ocular medications were initially selected and 11 medications were included in the final analysis because a product website was available. AChecker and WAVE tools were used to evaluate accessibility of each drug product homepage then a screen reader was used to verify accessibility of the websites. Descriptive statistics were used to represent the errors and problems identified by the accessibility checkers.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eAll websites had varying number of errors and problems based on the WAVE and AChecker tool. Travatan Z\u0026reg; had the highest number of errors of 117 according to WAVE and Durysta\u0026trade; had the highest of 42 problems based on the AChecker tool. Some of the common issues identified by the screen reader included lack of alternative text for images (e.g., graphs), no description for links, and drop-down menus do not expand using the keyboard functions.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThis study highlights the need for manufacturers to improve accessibility of their product websites. Due to the lack of accessible content on these websites, it is prudent for pharmacists and other healthcare professionals to provide education through verbal counseling and providing auditory resources or recordings of drug information as an alternative format.\u003c/p\u003e","manuscriptTitle":"Accessibility of Drug Information on Ocular Drug Product Websites in the United States","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-06-03 09:22:58","doi":"10.21203/rs.3.rs-4396551/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2024-06-29T14:05:50+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"134628086657779699101063040483325377943","date":"2024-06-29T14:04:38+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-05-28T15:08:26+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-05-28T15:07:30+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-05-21T19:07:39+00:00","index":"","fulltext":""},{"type":"submitted","content":"Universal Access in the Information Society","date":"2024-05-09T17:17:58+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"universal-access-in-the-information-society","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"uais","sideBox":"Learn more about [Universal Access in the Information Society](http://link.springer.com/journal/10209)","snPcode":"10209","submissionUrl":"https://submission.nature.com/new-submission/10209/3","title":"Universal Access in the Information Society","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"2d78d695-37da-4d5f-bd63-0b4c6b2d4384","owner":[],"postedDate":"June 3rd, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2024-08-01T16:17:40+00:00","versionOfRecord":{"articleIdentity":"rs-4396551","link":"https://doi.org/10.1007/s10209-024-01134-x","journal":{"identity":"universal-access-in-the-information-society","isVorOnly":false,"title":"Universal Access in the Information Society"},"publishedOn":"2024-07-16 16:05:17","publishedOnDateReadable":"July 16th, 2024"},"versionCreatedAt":"2024-06-03 09:22:58","video":"","vorDoi":"10.1007/s10209-024-01134-x","vorDoiUrl":"https://doi.org/10.1007/s10209-024-01134-x","workflowStages":[]},"version":"v1","identity":"rs-4396551","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4396551","identity":"rs-4396551","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}